Avoidant Restrictive Food Intake disorder (hereafter referred to as ARFID) was first officially described in the 2013 iteration of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5), but the symptom presentation is not new [1]. Prior to the ARFID diagnosis, many patients may have been diagnosed with eating disorder not otherwise specified, specific phobia, or simply labeled a “picky eater”. The DSM-5 describes ARFID as below:The exact prevalence of ARFID is unknown but thought to have equal distribution in males and females. It typically arises in early childhood, but when left untreated, can persist into adulthood. ARFID can arise in individuals from all racial and ethnic backgrounds and socioeconomic status, and there are commonly other immediate and extended family members who also experience eating challenges. Family dynamics do not cause ARFID, but high criticism, expressed emotion, and challenges setting firm and consistent boundaries may make recovery challenging. ARFID may present alongside other co-occurring mental health conditions and is often seen in patients with autism spectrum disorders, anxiety disorders, attention deficit hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD). Acute food refusal can be a hallmark of pediatric autoimmune neuropsychiatric disorders (PANS) as well.